Bioethics: A Primer for Christians

Index

Preface to the Fourth Edition

Because this primer continues to be read and used, it seems appropriate to bring it out in a fourth edition. I have brought the text up to date in quite a few places where that seemed to be needed; I have slightly increased the discussion of protecting physicians’ consciences in the practice of medicine; and I have noted the implications of recent advances in genetics (in particular, the CRISPR/Cas9 method of gene editing). Bioethical questions continue to be at the heart of many of our society’s difficult moral problems. It is, therefore, important—even necessary—that Christians try to think about these problems within a perspective that is shaped by the structure of Christian belief. But once again, as in earlier editions of this book, I emphasize that others are also welcome and invited to listen in.

Preface to the Third Edition

Iam pleased that Eerdmans has seen fit to publish a third edition of this little book and that it continues to find readers. Without making major changes or adding any entirely new chapters, I have updated and refined the text at any number of places. I have also added in chapter eight a brief discussion of the need to protect Christian conscience in the practice of medicine, an issue of increasing concern in our society. It remains true, as I said in the preface to the second edition, that this is a book written by a Christian chiefly for other Christians, but that all are welcome and invited to listen in.

Preface to the Second Edition

This book was first published slightly less than ten years ago, hardly a long time in world-historical terms. Yet, in the rapidly moving field of bioethics—which, as a field, has been around for four decades at the most—ten years is a long time indeed. For several years I have felt the need to update this primer, and this second edition is the result.

Here I simply summarize for those who may wish to know the principal changes I have made from the first edition. They are, I think, four. First, the whole of the text has been updated at various points in order to make the data given more current. This is not a book primarily about data or statistics; nevertheless, there were places where it seemed important to use more recent information, and I have done so. Second, at one point—in chapter three—my thinking has shifted somewhat, and I have altered the substance, or at least the tone, of the argument. In the first edition, without precisely committing myself to the view that a new individual human being comes into existence only after twinning has or has not occurred, I gave considerable weight to that possibility. I am now, for both empirical and metaphysical reasons, far less persuaded. Indeed, I think it likely that the argument that individuality is not established until approximately fourteen days of development is not going to stand the test of the embryological evidence and is likely to seem increasingly arbitrary. So I have revised the text at that point. Third, I have not only updated but also somewhat rewritten chapter nine (on organ donation). Although my position remains substantially unchanged, I think the tone of the argument is altered somewhat. Moreover, I have rewritten it in such a way as to take note (at least) of ongoing debates about the concept of brain death—an argument which I regard as still unfinished. Finally, I have added a new chapter in order to take up one special and highly controverted issue in research ethics: namely, research on embryos. With the possibility of the isolation of embryonic stem cells (involving destruction of embryos in the process), and with the looming possibility of cloning embryos for research purposes, this is an issue that has been of great importance in public debates. I did not think a general discussion of research ethics, without some special attention to this issue, was adequate.

The basic tone and tenor of the book remain unchanged. It is still true that this is a book written by a Christian chiefly for other Christians who want to think about some of the central issues in bioethics—though, of course, as I say in the book’s introduction, others are welcome to listen in and consider how these issues look from the perspective of Christian vision.

Introduction: An Approach to Bioethics

The pace of medical advance in our world is so rapid that we may easily forget just how recent is the growth of bioethics as a distinct area of concern. In the minds of our children organ donation and transplantation have become facts of life; yet the first successful kidney transplant took place in 1954 and the first heart transplant as recently as 1967. Our children may assume that a pregnant woman should have the health of her fetus screened in utero , should know before birth whether her child is male or female, and should consider abortion for any of a number of reasons; yet, amniocentesis was first performed in 1966, and the Roe v. Wade decision was handed down in 1973. We may assume that it is good for us to draw up advance directives about how we want to be treated if we become unconscious or otherwise incompetent, but the first living will law in this country (in the state of California) was passed in 1976. Many people simply assume that feeding tubes should be withdrawn from permanently unconscious patients; yet that step was not even seriously considered by the Quinlan family in 1976 when they went to court seeking to gain control over the medical care given their daughter Karen.

Something that might be called medical ethics has, of course, been present for a long time in the Western world. The Hippocratic Oath probably dates from the fourth century BC, and physicians—even in ages when they had none of the modern techniques for healing—reflected on the demands of their calling. After World War II, because of the deep involvement of German physicians in the Nazi regime’s program of human experimentation, eugenics, and genocide, the ethics of medicine received new attention. And, indeed, the Nuremberg Code that was formulated as a response to those abuses has today the status of international law.

Only, however, over the past half century at most has a discipline of bioethics developed, and only in these years have bioethical concerns become commonplace in our everyday lives. But as the concerns have become commonplace, they have also become the specialized possession of bioethicists, a development that may not be wholly salutary. There was a time when philosophers and theologians, in their respective ways, thought about the moral life, and physicians reflected upon the moral meaning of their practice. Then ethics developed as a specialized branch of philosophy or theology. Now we have bioethics, one branch of what is often called applied ethics. One of the things that happens in the course of this development is that bioethical reflection comes to focus more and more upon public policy—which in our society inevitably means a minimal, lowest common denominator ethic capable, it is thought, of securing public consensus. In this process, reflection upon the moral meaning of health and medicine becomes increasingly secularized—driven by the view that public consensus must exclude the larger questions about human nature and destiny that religious belief raises.

There is a place for such a minimalist bioethic, but this book aims at something different. I write as a Christian for other Christians who want to think about these issues. Anyone is, of course, welcome to listen in and consider what the world looks like from this angle of vision, but the discussion is not aimed at anyone. It is aimed at those who name as Lord the God of Abraham, Isaac, and Jacob—and who believe that this Lord lived as one of us in Jesus of Nazareth. The two testaments of Christian Scripture bear witness to this God and authoritatively (even if often ambivalently) shape the vision of Christians when they turn to the contemporary concerns of bioethics. It is obvious, of course, as a matter of empirical fact, that not all Christians agree with the judgments I make in this book. But when I attempt here to write Christian ethics, I do not mean that I have taken a survey of the opinions of Christians or written a history of their views. Rather, I have tried to say what we Christians ought to say in order to be faithful to the truth that has claimed us in Jesus. A person could not attempt to speak normatively in behalf of the church unless, in Karl Barth’s words, in all humility he was willing to risk being such a Church in his own place and as well as he knew how.¹ That, I confess, I attempt here. The problems may often be new and driven by technological advance, but the search for human wisdom and faithful insight requires of us a longer memory and a more expansive vision.

1. Karl Barth, Church Dogmatics, I/1 (Edinburgh: T&T Clark, 1936), xii.

CHAPTER ONE

Christian Vision

Although a great deal of the best work in bioethics has involved the application of certain ethical principles—such as respect for autonomy, beneficence, and justice—to particular issues of concern, there is no way to apply principles in a vacuum. How we understand such principles, and how we understand the situations we encounter, will depend on background beliefs that we bring to moral reflection—beliefs about the meaning of human life, the significance of suffering and dying, and the ultimate context in which to understand our being and doing. Our views on such matters are shaped by reasoned argument and reflection less often than we like to imagine. Our background beliefs are commonly held at a kind of prearticulate level. We take them in with the air we breathe, drink them in from the surrounding culture. It is, therefore, useful sometimes to call to mind simply and straightforwardly certain basic elements in a Christian vision of the world—to remind ourselves of how contrary to the assumptions of our culture that vision may be. Hence, before we turn in the following chapters to complicated issues in bioethics, we do well to reflect briefly upon some of our background beliefs.

Individuals in Community

Bioethics talk is often talk about rights. Such talk is absolutely essential in many contexts. To ignore it is to ignore the just claims of others upon our attention and our care. But for Christians the relation of individual and community is too complex to be dealt with by such language alone, and I therefore begin with a different language.

In baptism we are handed over to God and become members of the Body of Christ. That is language about a community; yet, perhaps paradoxically, the first thing to note about baptism is that it is a deeply individualizing act. Our parents hand us over, often quite literally when sponsors carry us as infants to the font. Deeply bound as we are and always will be to our parents, we do not belong to them. In baptism God sets his hand upon us, calls us by name, and thereby establishes our uniquely individual identity and destiny.

We belong, to the whole extent of our being, only to God, whom we must learn to love even more than we love father or mother. What makes us true individuals therefore is that God calls us by name. Our individuality is not a personal achievement or power, and—most striking of all—it is established only in community with God. We are most ourselves not when we seek to direct and control our destiny but when we recognize and admit that our life is grounded in and sustained by God.

If the first thing to say about baptism is that it establishes our individual identity, we must immediately add that it brings us into the community of the church—with all those whom God has called by name. It is utterly impossible to exist in relation to God apart from such a bond with all others who have been baptized into Christ’s Body. We are called to bear their burdens as they are called to carry ours. Sometimes we are reluctant to shoulder theirs. At least as often, perhaps, we are reluctant to have them shoulder ours, so eager are we to be masterful and independent. That others within the Body should burden us and that we should burden them is right and proper if the life of the Body is one. Nor should such mutual burdensomeness be ultimately destructive, since Jesus has been broken by these burdens once for all.

If baptism is the sacrament of initiation into Christian life, it should inform our understanding of individualism. We should not suppose that any individual’s dignity can be satisfactorily described by the language of autonomy alone—as if we were most fully human when we acted on our own, chose the course of our life plan, or were capable and powerful enough to burden no one.

There will still remain—and should remain—a place within the political realm for the language of independent individualism. Christians should recognize that, in a world deeply disturbed by sin, great evil can be done in the name of community. Herbert Butterfield, the distinguished British historian, once suggested—only somewhat with tongue in cheek—that one could adequately explain all the wars fought in human history simply by taking the animosity present within the average church choir at any moment and giving it a history extended over time. Because sin distorts every human relationship, because, in particular, it leads the powerful to abuse and diminish the weak and voiceless in the name of high ideals or the common good, every individual’s dignity must be protected.